Evolution of pneumococcal infections in adult patients during a four-year period after vaccination of a pediatric population with 13-valent pneumococcal conjugate vaccine

This review describes development of currently available pneumococcal vaccines, provides summary tables of current pneumococcal vaccine recommendations in children and adults, and describes new potential vaccine antigens in the pipeline. Streptococcus pneumoniae, the bacteria responsible for pneumonia, otitis media, meningitis and bacteremia, remains a cause of morbidity and mortality in both children and adults. Introductions of unconjugated and conjugated pneumococcal polysaccharide vaccines have each reduced the rate of pneumococcal infections caused by the organism S. pneumoniae. The first vaccine developed, the 23-valent pneumococcal polysaccharide vaccine (PPSV23), protected adults and children older than 2 years of age against invasive disease caused by the 23 capsular serotypes contained in the vaccine. Because PPSV23 did not elicit a protective immune response in children younger than 2 years of age, the 7-valent pneumococcal conjugate vaccine (PCV7) containing seven of the most common serotypes from PPSV23 in pediatric invasive disease was developed for use in children younger than 2 years of age. The last vaccine to be developed, the 13-valent pneumococcal conjugate vaccine (PCV13), contains the seven serotypes in PCV7, five additional serotypes from PPSV23, and a new serotype not contained in PPSV23 or PCV7. Serotype replacement with virulent strains that are not contained in the polysaccharide vaccines has been observed after vaccine implementation and stresses the need for continued research into novel vaccine antigens. We describe eight potential protein antigens that are in the pipeline for new pneumococcal vaccines.

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Prevention ofStreptococcus pneumoniae(pneumococcal) infections in adults

Orvosi Hetilap ◽

10.1556/oh.2014.30070 ◽

2014 ◽

Vol 155 (50) ◽

pp. 1996-2004 ◽

Cited By ~ 2

Author(s):

Endre Ludwig ◽

Zsófia Mészner

Keyword(s):

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Infection ◽

Polysaccharide Vaccine ◽

Diagnostic Tools ◽

Renal Diseases ◽

Pneumococcal Polysaccharide Vaccine ◽

Pneumococcal Infections ◽

Incidence And Mortality ◽

One Year

Infections caused by Streptococcus pneumoniae (pneumococcus) are still meaning a serious health problem, about 40% of community acquired pneumonia (CAP) is due to pneumococcal bacteria in adults requiring hospitalization. The incidence and mortality rate of pneumococcal infections is increasing in the population above 50 years of age. Certain congenital and acquired immunocompromised conditions make the individual susceptible for pneumococcal infection and other chronic comorbidities should be considered as a risk factor as well, such as liver and renal diseases, COPD, diabetes mellitus. Lethality of severe pneumococcal infections with bacteraemia still remains about 12% despite adequate antimicrobial therapy in the past 60 years. Underestimation of pneumococcal infections is mainly due to the low sensitivity of diagnostic tools and underuse of bacteriological laboratory confirmation methods. 13-valent pneumococcal conjugate vaccine (PCV-13) became available recently beyond the 23-valent polysacharide vaccine (PPV-23) which has been using for a long time.The indication and proper administration of the two vaccines are based on international recommendations and vaccination guideline published by National Centre for Epidemiology (NCE):Pneumococcal vaccination is recommended for: Every person above 50 years of age. Patients of all ages with chronic diseases who are susceptible for severe pneumococcal infections: respiratory (COPD), heart, renal, liver disease, diabetes, or patients under immunsuppressive treatment. Smokers regardless of age and comorbidities. Cochlear implants, cranial-injured patients. Patients with asplenia.Recommendation for administration of the two different vaccines:Adults who have not been immunized previously against pneumococcal disease must be vaccinated with a dose of 13-valent pneumococcal conjugate vaccine first. This protection could be extended with administration of 23-valent pneumococcal polysaccharide vaccine at least two month later. Adults who have been immunized previously, but above 65 years of age, with a 23-valent polysaccharide vaccine are recommended to get one dose of conjugate vaccine at least one year later. Adults who have been immunized previously, but under 65 years of age, with a 23-valent polysaccharide vaccine are recommended to get one dose of conjugate vaccine at least one year later. After a minimal interval of two months one dose of 23-valent pneumococcal polysaccharide vaccine is recommended if at least 5 years have elapsed since their previous PPSV23 dose. Vaccination of immuncompromised patients (malignancy, transplantation, etc.) and patients with asplenia should be defined by vaccinology specialists. Pneumococcal vaccines may be administered concommitantly or any interval with other vaccines. Orv. Hetil., 2014, 155(50), 1996–2004.

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Invasive Pneumococcal Infections in Children Following Transplantation in the Pneumococcal Conjugate Vaccine Era

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv131.02 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Author(s):

Liset Olarte ◽

Philana Ling Lin ◽

William J. Barson ◽

Jose R. Romero ◽

Jill Hoffman ◽

...

Keyword(s):

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Infections

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An observational study of the reactogenicity and immunogenicity of 13-valent pneumococcal conjugate vaccine in women of childbearing age in Papua New Guinea

Pneumonia ◽

10.1186/s41479-020-00076-1 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Sarah Javati ◽

Geraldine Masiria ◽

Arthur Elizah ◽

John-Paul Matlam ◽

Rebecca Ford ◽

...

Keyword(s):

High Risk ◽

Observational Study ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Early Life ◽

Women Of Childbearing Age ◽

Pneumococcal Infections ◽

Childbearing Age ◽

Igg Antibody ◽

Young Infants

Abstract Background Maternal immunization with pneumococcal conjugate vaccine (PCV) may protect young infants in high-risk settings against the high risk of pneumococcal infections in early life. The aim of this study was to determine the safety and immunogenicity of 13-valent PCV (PCV13) in healthy women of childbearing age in PNG. Methods As part of this observational study, 50 non-pregnant women of childbearing age (18-45 yrs. old) living in the highlands of PNG were vaccinated with a single dose of PCV13. Local and systemic reactogenicity were assessed 24–48 h after vaccination. Venous blood samples were collected before and 1 month after vaccination to measure PCV13 serotype-specific IgG antibody concentrations. Results No severe adverse effects were reported during the 1-month follow-up period. IgG antibody concentrations significantly increased after vaccination for all PCV13 serotypes. One month after vaccination IgG antibody levels ≥2.5 μg/mL were reached in at least 75% of women for all PCV13 serotypes, except serotype 3, and ≥ 5 μg/mL in at least 75% of women for 7 serotypes (serotypes 6B, 9 V, 14, 18C, 19A, 19F and 23F). Conclusion PCV13 is safe and immunogenic in women of childbearing age living in a high-risk setting in PNG. This supports the implementation of studies to investigate the safety and immunogenicity of maternal PCV vaccination in high-risk settings as a strategy to protect infants in these settings against the high risk of pneumococcal infections in early life. Trial registration NCT04183322. Registered 3 December 2019 - Retrospectively registered

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Pneumococcal vaccine in adults reduces the risk of infections caused by Streptococcus pneumoniae

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2016-94-1-61-66 ◽

2016 ◽

Vol 94 (1) ◽

pp. 61-66

Author(s):

Yulia G. Belocerkovskaja ◽

A. G. Romanovskih ◽

E. A. Styrt

Keyword(s):

Streptococcus Pneumoniae ◽

Conjugate Vaccine ◽

Pneumococcal Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Risk Group ◽

Severe Disease ◽

Polysaccharide Vaccine ◽

Pneumococcal Vaccines ◽

Pneumococcal Polysaccharide Vaccine ◽

Pneumococcal Infections

Streptococcus pneumoniae is a major cause of severe disease worldwide, particularly in the risk population. Two pneumococcal vaccines are currently available for specific prevention of pneumococcal infections among adults in Russia: a 23-valent pneumococcal polysaccharide vaccine (PPSV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). The article describes modern views on the effectiveness and safety of two pneumococcal vaccines in adults with underlying medical conditions and adults aged ≥65 years and provides current recommendations for routine use of PPSV23 and PCV13 among persons included in the risk group.

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Noninvasive Streptococcus pneumoniae Serotypes Recovered from Hospitalized Adult Patients in the United States in 2009 to 2012

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00182-15 ◽

2015 ◽

Vol 59 (9) ◽

pp. 5595-5601 ◽

Cited By ~ 17

Author(s):

Rodrigo E. Mendes ◽

Rosalind C. Hollingsworth ◽

Andrew Costello ◽

Ronald N. Jones ◽

Raul E. Isturiz ◽

...

Keyword(s):

United States ◽

Streptococcus Pneumoniae ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Respiratory Infections ◽

Adult Population ◽

The United States ◽

Adult Patients ◽

Content Type ◽

Trends Over Time

ABSTRACTThis study was conducted to determine the serotype distribution and trends over time ofStreptococcus pneumoniaestrains associated with noninvasive infections among adult patients ≥18 years of age in the United States (2009 to 2012). A total of 2,927S. pneumoniaeisolates recovered from patients presenting with respiratory infections and obtained mainly (87.0%) from lower respiratory tract specimens (sputum) were included. The levels of the 7-valent pneumococcal conjugate vaccine (PCV7) serotypes remained stable over the 4-year study period (4.6% to 5.5%;P= 0.953). Overall, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes were identified in 32.7% of samples, declining from 33.7% to 35.5% in 2009 to 2011 to 28.2% in 2012 (P= 0.007), with a significant decrease in the levels of serotypes 7F (P= 0.013) and 6A (P= 0.010). The levels of 19A remained constant (15.8% to 17.1%) during 2009 to 2011, dropping to 12.2% in 2012 (P= 0.089). The prevalence of serotypes associated with the 23-valent pneumococcal polysaccharide vaccine (PPSV23), but not PCV13, remained generally stable; however, the prevalence of serotypes 15B and 15C (15B/15C) increased from 2.7% to 6.3% (P= 0.010). The proportion of nonvaccine serotypes increased gradually during the study period (P= 0.044), particularly for serotype 35B (from 3.6% in 2009 to 8.2% in 2012;P= 0.001). Nonsusceptibility rates for penicillin (susceptible breakpoint, ≤2 μg/ml) and clindamycin against PCV7 serotypes decreased over the period. These results suggest the emergence of indirect effects following introduction of PCV13 for infants and young children; continued surveillance is needed to assess the burden of PCV13 serotypes in the adult population after the implementation of age-based recommendations in the United States.

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Impact of Pneumococcal Conjugate Vaccine on Pediatric Tympanostomy Tube Insertion in Partial Immunized Population

The Scientific World JOURNAL ◽

10.1155/2015/248678 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8

Author(s):

Mao-Che Wang ◽

Ying-Piao Wang ◽

Chia-Huei Chu ◽

Tzong-Yang Tu ◽

An-Suey Shiao ◽

...

Keyword(s):

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pediatric Population ◽

Age Groups ◽

Period Effect ◽

Research Database ◽

Birth Cohorts ◽

Tube Insertion ◽

Effect Analysis ◽

The Impact

Objective. To investigate the impact of seven-valent pneumococcal conjugate vaccine on tube insertions in a partial immunized pediatric population.Study Design. Retrospective ecological study.Methods. This study used Taiwan National Health Insurance Research Database for the period 2000–2009. Every child under 17 years old who received tubes during this 10-year period was identified and analyzed. The tube insertion rates in different age groups and the risk to receive tubes in different birth cohorts before and after the release of the vaccine in 2005 were compared.Results. The tube insertion rates for children under 17 years of age ranged from 21.6 to 31.9 for 100,000 persons/year. The tube insertion rate of children under 2 years old decreased significantly after 2005 in period effect analysis (β= −0.074,P< 0.05, and the negativeβvalue means a downward trend) and increased in children 2 to 9 years old throughout the study period (positiveβvalues which mean upward trends,P< 0.05). The rate of tube insertion was lower in 2004-2005 and 2006-2007 birth cohorts than that of 2002-2003 birth cohort (RR = 0.90 and 0.21, 95% CI 0.83–0.97 and 0.19–0.23, resp.).Conclusion. The seven-valent pneumococcal conjugate vaccine may reduce the risk of tube insertion for children of later birth cohorts. The vaccine may have the protective effect on tube insertions in a partial immunized pediatric population.

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Early Trends for Invasive Pneumococcal Infections in Children After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0b013e318275614b ◽

2013 ◽

Vol 32 (3) ◽

pp. 203-207 ◽

Cited By ~ 209

Author(s):

Sheldon L. Kaplan ◽

William J. Barson ◽

Philana Ling Lin ◽

José R. Romero ◽

John S. Bradley ◽

...

Keyword(s):

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Infections

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Effects of Probiotic Mixture Supplementation on the Immune Response to the 13-Valent Pneumococcal Conjugate Vaccine in People Living with HIV

Nutrients ◽

10.3390/nu13124412 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4412

Author(s):

Marcella Reale ◽

Claudio Ucciferri ◽

Erica Costantini ◽

Marta Di Di Nicola ◽

Annamaria Porreca ◽

...

Keyword(s):

Immune Response ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Opportunistic Infections ◽

The Elderly ◽

People Living With Hiv ◽

Pneumococcal Infections ◽

Risk Of Death ◽

Before And After ◽

Living With Hiv

Background: In people living with HIV, combination antiretroviral therapy (cART) reduces the risk of death, but the persistent immune-deficient state predisposes them to pneumococcal infections. Current guidelines encourage administering pneumococcal vaccine Prevenar 13 to patients living with HIV. Since probiotic supplementation could act as adjuvants and improve vaccine immunogenicity by modulating gut microbiota, the present study aimed to assess whether the effect of a formulation containing a combination of specific probiotics (Vivomixx®) could improve the immune response to 13-valent pneumococcal conjugate vaccine (PCV13) in adult people living with HIV. Methods: Thirty patients who were clinically stable and virologically suppressed, without opportunistic infections during this time and no ART changes in the 12 months before the study started were enrolled. Patients were divided into two groups: (1) received a placebo dose and (2) received Vivomixx® (1800 billion CFU) for four weeks before and after the vaccination with a single dose of PCV13. Results: Vivomixx® supplementation induced a better response to PCV13 immunization, as shown by greater change in anti-Pn CPS13 IgG and increase in salivary IgA, IL-10 and IL-8. Conclusions: Additional investigations will help to clearly and fully elucidate the optimal strains, doses, and timing of administration of probiotics to improve protection upon vaccination in immunocompromised individuals and the elderly.

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Prevalence of Severe Bacterial Infection in Febrile Children with Sickle CELL Disease in the Era of Pneumococcal Conjugate Vaccine 13

Blood ◽

10.1182/blood-2018-99-111362 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3665-3665

Author(s):

Gloria Contreras-Yametti ◽

Custodio Haidee ◽

Hamayun Imran

Keyword(s):

Sickle Cell Disease ◽

Conjugate Vaccine ◽

Sickle Cell ◽

Pneumococcal Conjugate Vaccine ◽

Univariate Analysis ◽

Cell Disease ◽

Pneumococcal Infections ◽

Patient Disposition ◽

Penicillin Prophylaxis ◽

Febrile Events

Abstract Introduction The incidence of invasive pneumococcal infections in patients with sickle cell disease (SCD) decreased after introduction of penicillin prophylaxis and pneumococcal conjugate vaccine (PCV). However, the decrease in pneumococcal infections alone may not necessarily mean an overall decrease in severe bacterial infections (SBI). In a previous publication, we reported a 0.4 % prevalence of pneumococcal bacteremia following introduction of PCV 13. In the current study, we aimed to define the prevalence of SBI and hospitalization in febrile patients in the same cohort in the later years. Methods We performed a retrospective study of patients with SCD <18 years old presenting with fever to University of South Alabama Children's and Women's Hospital from January 2014 to June 2017. SBI was defined as: bacteremia, pneumonia, pyelonephritis, meningitis, osteomyelitis and abscess (superficial and deep). Univariate analysis and multivariate logistic regression were used to determine factors associated with patient disposition as well as presence of SBI. Results There were 258 febrile events in 120 patients resulting in 187 (72%) admissions (figure 1). SBI was seen in 12% of admissions with uncomplicated community acquired pneumonia being the most common. The prevalence of bacteremia was 1.6% with single cases of pneumococcus, E. coli, and H. influenzae bacteremia. Younger age, high fever, and splenectomy were associated with hospitalization (p<0.05). However, only C reactive protein was associated with SBI (p<0.02). Viral infection was diagnosed in 80% of outpatients but 87% were given antibiotics. Among inpatients, all received parenteral antibiotics, and 67% were assessed to have viral illness, although only 23% had a virus identified. Pneumococcal vaccination status was satisfactory in 77% of our sample while compliance rate with penicillin prophylaxis was >85% in both inpatient and outpatient groups. Conclusion Although majority of febrile events were due to viral infections, 3 of four febrile episodes in our cohort resulted in hospitalization. A small proportion of patients had SBI and a much smaller proportion had bacteremia. These findings support early virus identification which can have implications on patient discharge disposition and antibiotic use. Further studies looking at risk stratification of febrile patients with SCD are needed to encourage outpatient management without compromising safety. Figure 1. Figure 1. Disclosures Imran: Novo Nordask: Speakers Bureau.

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